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We are a group of transgender, nonbinary, and allied mental health and medical providers based in the U.S. who have come together to:

a)    State our position on the requirement that transgender and nonbinary people and/or people seeking gender-affirming medical interventions acquire a letter of support from a mental health provider;

b)   Make public our commitment to making letters, when required by medical systems who adhere to the WPATH SOC, accessible and free.


  • We advocate for an informed consent model as it would apply to any medical service or surgery.
  • People seeking gender-affirming medical care have a right to information in order to evaluate risks and benefits and feel empowered in their medical decision-making.
  • Information sharing DOES NOT need to be in the form of individual sessions with mental health providers unless chosen by the client. There are other methods of making this information accessible, including: classes, print materials, online materials, and greater transparency from medical providers. These resources may not be available or established in all health care systems, but this is a standard of care that all systems should be investing in building.
  • We are aware that people who do not fit a certain narrative about what it means to be “transgender” often receive subpar care and face more barriers to receiving the care they need. We acknowledge that this greatly impacts people of color and indigenous communities, nonbinary people, and neurodivergent people.
  • Putting mental health providers in a position of gatekeeping negatively impacts the client-provider relationship and leads to abuses of power. Furthermore, therapy services should always be consensual; requiring clients to pay for services which they are, in some cases, not needing or wanting, is unethical. This is not client-centered care.


It may be years before clinical practice shifts toward a more socially just model. We aim to raise awareness in order to shift the culture of compulsory letters by eliminating the share of cost from our clients. We recognize that this movement is only an intermediary step towards a more ethical, just, and accessible model of gender-affirming care.


  1. Stop participating in and profiting from a cycle that is physically, emotionally, and financially damaging, exploitative, unethical, and disempowering to transgender and nonbinary people. We urge those who are not a member of historically marginalized communities, particular those with cisgender and/or white skin privilege, to reflect deeply on their practices and take action that is in solidarity with the self-determination and sovereignty of people in trans and nonbinary communities.
  2. Publicly commit to providing gender-affirming care for medical transition without undue gatekeeping practices.
  3. Provide pro bono assessments and letters to people who are seeking our services solely for this purpose. As mental health providers, our ethics codes state that we should be providing some pro bono work.  For clinicians who truly care about social justice, financial redistribution, and improved access to care, this is a way to align our values with our clinical practice.
  4. Form networks to provide free or low-cost training to other mental health providers who would like to perform this service. We view this as capacity building that can support quality service provision.


The GALAP is not a health system, service, or group psychotherapy practice. We are independent clinicians, and we practice as such. We do not represent any particular organization. While all of the providers who sign our pledge are committed to providing gender affirming care, The GALAP is not liable for the work of any of the pledge signers and cannot attest to the skills or expertise of anyone who signs the pledge.

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